In an analysis of more than half a million pregnancies, there was no indication that taking anti-depressants during pregnancy increased the risk of children developing autism or attention deficit hyperactivity disorder (ADHD), reports The Guardian.
The study, conducted by a team from the University of Hong Kong and published in The Lancet Psychiatry, analysed data from 37 existing studies that included 600 000 pregnant women who had taken anti-depressants, and 25m women who took none at all during their pregnancies.
Before controlling for key factors like pre-existing mental health conditions, the analysis found that anti-depressant use by the mother during pregnancy was associated with a 35% increased risk of ADHD and a 69% increased risk of autism.
However, when controlling for confounding factors such as pre-existing mental health conditions, this risk became non-significant. This means the meta-analysis found no significant link between anti-depressant use during pregnancy and a greater risk of autism and ADHD in children, after controlling for the mother’s mental health or other influencing factors such as genetics.
Dr Wing-Chung Chang, a Professor at the University of Hong Kong and lead author of the study, said: “We know many parents-to-be worry about the potential impact of taking medication during pregnancy; our study provides reassuring evidence that commonly used anti-depressants do not increase the risk of neurodevelopmental disorders like autism and ADHD in children.
“While all medications carry risks, so too does stopping anti-depressants during pregnancy due to an increased risk of relapse. Therefore, for women with moderate-severe depression, doctors and patients must carefully weigh the potential risks and benefits of continuing the treatment during pregnancy against the potential harms of untreated depression.
“Although our study found a small increase in the risk of autism and ADHD in the children of women who had used anti-depressants during pregnancy, it also found that this risk disappeared when we accounted for other factors. The increased risk was also seen in the children of fathers who took anti-depressants and of mothers with anti-depressant use before, but not during, pregnancy.
“Combined, this suggests that it is not the medications themselves causing an increased risk in autism and ADHD but it is more likely to be due to other factors, including genetic predisposition to conditions such as ADHD, autism, and mental health conditions.”
The study also found no difference in risk between high and low doses. Limitations of the study included the lack of data on socio-economic status, lifestyle risk factors and low birth rate. Furthermore, women who are prescribed anti-depressants tend to have more severe depression than those who are not, so some bias may remain even after controlling for factors such as mental health status.
James Walker, a Professor Emeritus of Obstetrics and Gynaecology at the University of Leeds, said the research had helped to “cut through the noise” regarding recent concerns about whether medications taken by mothers during pregnancy could affect their babies.
“The practical message is straightforward” Walker said. “Women with moderate or severe depression should not stop their anti-depressants in pregnancy out of fear of causing autism or ADHD. Depression that goes untreated in pregnancy carries real risks of its own, for the mother, the pregnancy and for the developing baby, including a higher chance of premature birth, postnatal depression and difficulties bonding with the baby.
“For milder depression, talking therapies and other non-medication approaches are usually tried first, in line with current guidelines. As always, decisions in pregnancy are personal and should be made with a clinician who knows the woman’s history.”
Study details
Maternal and paternal anti-depressant use before and during pregnancy and offspring risk of neuro-developmental disorders: a systematic review and meta-analysis
Joe Kwun Nam Chan, Alan Hung Fai Zhong, Jacko Yat Hei Lam et al.
Published in The Lancet Psychiatry in June 2026
Summary
Background
The potential risk of neuro-developmental disorders after prenatal anti-depressant exposure is concerning. Meta-analyses conducted in the past decade have had small study numbers and insufficient assessment of confounding by treatment indication. We aimed to synthesise risk of neuro-developmental disorders, including ADHD and autism spectrum disorder (ASD), with antidepressant exposure before or during pregnancy in mothers and fathers, accounting for anti-depressant classes, agents, dose, and confounding.
Methods
In this systematic review and meta-analysis, we searched Embase, MEDLINE, PsycINFO, and Web of Science from database inception to May 14, 2025, for studies that included mothers or fathers with anti-depressant use before or during the pregnancy period and that reported data on neuro-developmental disorders. Relative risks (RRs) were pooled using random-effect meta-analyses. We assessed publication bias, subgroup analyses, and quality assessment (Newcastle-Ottawa scale). No people with relevant lived experience were involved in the research and writing process. Only two studies reported ethnicity data. This study is registered with PROSPERO (CRD420251052595).
Findings
We identified 37 studies involving 648 626 anti-depressant-exposed and 24 967 806 unexposed pregnancies (weighted average mean age 28·8 years, range 28·5–32·3). Prenatal anti-depressant use was associated with a modestly increased risk of neuro-developmental disorders in offspring (RR 1·13, 95% CI 1·08–1·18; k=2; I2=64·9%; p=0·051), including ADHD (1·35, 1·24–1·47; k=14; I2=90·2%; p<0·0001) and ASD (1·69, 1·24–2·30; k=25; I2=98·1%; p<0·0001), but not intellectual disabilities, motor disorders, or speech and language disorders. No significant difference in ASD risk was found between high-dose and low-dose exposure, and paternal anti-depressant use around conception was not linked to ASD. Both SSRI and non-SSRI anti-depressants exhibited increased risk for ADHD (SSRI 1·35, 1·20–1·51; k=11; I2=87·3%; p<0·0001; non-SSRI 1·41, 1·33–1·50; k=3; I2=0%; p=0·35) and ASD (SSRI 1·52, 1·39–1·65; k=21; I2=55·6%; p<0·0001; non-SSRI 1·19, 1·03–1·45; k=4; I2=0%; p=0·38). Notably, similar associations were found for pre-conception exposure. Observed associations were attenuated or became non-significant in sensitivity analyses accounting for confounding factors, such as maternal mental disorders, familial or genetic influences, and misclassification. Paternal anti-depressant use during pregnancy served as a negative control and was associated with increased ADHD risk (1·46, 1·38–1·56; k=2; I2=25·3%; p=0·24) and ASD risk (1·28, 1·16–1·40; k=6; I2=35·0%; p=0·20). When confounding by indication was minimised, only amitriptyline and nortriptyline were associated with increased risk of ADHD (amitriptyline 1·74, 1·00–3·03) or ASD (amitriptyline and nortriptyline 2·02, 1·32–3·10), whereas no significant associations were found for specific SSRIs or SNRIs. The certainty of evidence was low to very low.
Interpretation
This systematic review and meta-analysis indicated a small association between anti-depressants and ADHD or ASD, which was attenuated or became non-significant after adjusting for confounding factors. Anti-depressant treatment should be continued for pregnant women with moderate-to-severe depression. Optimising both maternal and paternal mental health is essential for the child's long-term neuro-development.
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